2008 Laparoscopic Injuries Flashcards
(19 cards)
How many women undergo laparoscopic surgery in the UK each year?
250,000
What is the rate of serious injuries at laparoscopy?
1:1000
What stage of laparoscopy has the greatest risk of injury?
Blind insertion
What is the laparoscopic rate of a) intestinal, b) urological & c) vascular injuries?
a) 0.4:1000
b) 0.3:1000
c) 0.2:1000
What complications should women be consented for with laparoscopy?
- Bowel injury
- Urinary tract injury
- Major blood vessel injury
- Hernia
Which women are at increased risk in laparoscopic surgery?
- Obese
- Significantly underweight
- Previous midline abdominal incision
- Previous peritonitis
- Inflammatory bowel disease
What are the major entry techniques?
- Veress: direct
- Hasson: open
- Direct trocar insertion eg Visiport
What are the important aspects of closed laparoscopic entry?
- Incision vertical from base of umbilicus
- Test spring action
- Horizontal table at the start
- Insert at right angle to skin
- Listen for 2 audible clicks
- Avoid excessive lateral movement
What should be done after 2 failed attempts at Veress entry?
Change to Hasson technique or Palmer’s point entry
What is the best way of ensuring correct Veress entry?
Observe initial insufflation pressure < 8mmHg
What intra-abdominal pressures should be used, a) before insertion of primary trocar, b) once insertion of trocars complete?
a) 20-25mmHg
b) 12-15mmHg
What are the important aspects of Hasson entry?
- Incise fascial edges
- Hold edges with lateral stay sutures
- Insert blunt-ended trocar
- Pull sutures into holders on side of cannula for airtight seal
- Insufflation via cannula
- Remove trocar
What is the best alternative site for primary trocar, and when isn’t it used?
Palmer’s point
Unless splenomegaly or previous surgery in that area
What is the rate of adhesion formation at the umbilicus after a) midline laparotomy, b) low transverse incision
a) 50%
b) 23%
Where is Palmer’s point?
3cm below left costal margin
Mid-clavicular line
Which vessels need to be avoided for the secondary trocar insertion, and what is the anatomical landmark?
Inferior epigastric vessels
Lateral to lateral umbilical ligaments (obliterated hypogastric arteries)
What size of port needs deep closure to avoid port site hernia?
Non-midline port >7mm
Midline port >10mm
Which entry technique is hardest for morbidly obese women, and how can problems be overcome?
Veress entry
Ensure 90• at base of umbilicus, allows 6cm distance, compared to 11-16cm at 45•
How close might the aorta be to the skin in anorexic women?
<2.5cm
